The HIV Equity Initiative

In 1998, against the advice of global health experts who doubted the efficacy of treating HIV in resource-poor settings, PIH launched the HIV Equity Initiative to provide free antiretroviral therapy to a handful of AIDS patients, using a community-based model that trains and employs local Haitians to administer medications daily and provide social support. This was the world’s first program to provide free, comprehensive HIV care and treatment in an impoverished setting. In 2000, this pilot effort was expanded across central Haiti. In spirit and execution it is based on our longstanding model of community-based tuberculosis control and care, which emphasizes adherence to treatment by enlisting community health workers to deliver therapy and provide social support. The impact and success of the HIV Equity Initiative rest on what are referred to as the "four pillars": combining AIDS prevention and treatment with programs to provide comprehensive primary care; advancing tuberculosis care; improving screening and treatment of sexually transmitted infections; and emphasizing women's health.

The demonstrated success of the HIV Equity Initiative contributed to the formation of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a multilateral, public-private partnership to finance the fight against the world’s deadliest infectious diseases. The decision by G8 countries to establish and support the Global Fund followed a call in April 2001 by UN Secretary General Kofi Annan for the creation of a “war chest” to fight AIDS. Since its launch in 2002, the Global Fund has created an innovative, demand-driven model where country-level grant applications are developed and submitted by a consortia of NGOs, government agencies, and organizations representing people living with HIV, TB, and malaria. Furthermore, the Fund’s procurement system helps countries and projects navigate purchases of low-cost, high-quality medicines, including antiretrovirals for AIDS.

Zanmi Lasante’s track record and innovative treatment protocols spurred the Global Fund to award Haiti one of its first grants in 2002. A strong endorsement of PIH’s community-based approach, the award, along with new funding from the U.S. Centers for Disease Control and Prevention and the President’s Emergency Plan for AIDS Relief (PEPFAR), allowed Zanmi Lasante to expand its medical services across the Central Plateau, with the goal of strengthening the public health infrastructure while providing antiretroviral therapy to more than 4,000 AIDS patients over the following three years.

By the end of that period, Zanmi Lasante had succeeded in expanding its HIV treatment and prevention efforts throughout the Central Plateau and beyond. In April of 2003, with Global Fund support and in partnership with the Haitian Ministry of Health, we expanded our facilities in Cange and at four new locations. ZL inaugurated rural Haiti’s second fully outfitted AIDS clinic in the town of Lascahobas. We also renovated and equipped an abandoned hospital in Boucan Carré and clinics in Belladère and Thomonde. The presence of a ZL clinic or hospital in these communities has renewed local faith in the health care system, stimulated demand for primary health care, reduced the stigma of HIV testing and treatment, and enhanced interest in prevention efforts. In the course of expanding our care of HIV-positive patients and their families, we have also significantly increased our ability to identify and treat patients with other diseases. The HIV Equity Initiative is now a global model for the delivery of community-based treatment for complex diseases within the context of comprehensive primary care.